Toward an Experiential Approach to Interprofessional Communication*

There is a famous quote from the movie Cool Hand Luke [1] when the prison warden
says to Luke right after hitting him, “What we’ve got here is failure to communicate;
some men you just can’t reach.” Aside from the entertaining drama, I keep
two implications from this quotation: communication is more than information
transfer, it is also about reach; and reach can be costly.

A dictionary definition reveals several meanings for the word “reach”: stretch out;
touch or grasp by stretching; arrive at; get in contact; and interestingly enough, “succeed
in having an effect on” [2]. I lean toward the latter, simply because thinking of
communication as exerting an influence offers a better chance of assessing that influence. Our goals must be smart and measurable. They must also consider local contexts.

Communication is central in an interprofessional context. Problems arise when
we treat communication mainly as an exchange of information and ignore all the
subtle non-verbal signifiers: attitudes, body language, cultural norms, and institutional
rules. Shannon and Weaver [3] offered a theory of communication as reliability
in encoding and decoding information as a set of symbols. We usually conceive
of communication as the transfer of a string of symbols with the assumption that the
syntactic rules are known—we get the meaning if we can decode the string. This
view is appealing. We see its usefulness in computers as they extend our minds every
day. It becomes, however, particularly costly with specialization and the increased
division of labour that is necessary for collective works. As it increases productivity,
specialization also brings with it elaborate algorithms that only experts know. A
higher level of energy must then be spent to encode and decode expert information—
a cost that can be prohibitive in an interprofessional context, which calls for
speed and efficiency in the integration and transfer of knowledge.

So if interprofessional communication is more than information transfer, and if
the division of labour increases both the productivity and the costs of communication,
what can we do? How can we better understand interprofessional communication?

First, we need to consider that an effective interprofessional group lowers the costs
of communication. The human history of collective work is filled with successive
attempts to reduce those costs and coordinate the exchange of energy—an important
part of what makes or breaks collective work. For what do groups do in the real world?
At a fundamental level, they exchange information and energy. In doing so, they
establish connections between agents and objects: the connections can be physical (as
in sharing the other end of the rope), symbolic (as in incentives), or mental (as in language and working memories in the brain). Group members not only exchange bits of information, they also negotiate meanings, and if they maintain long enough working
relationships, they can cultivate an enduring context for new knowledge [4,5].

Second, if as Lawn [6] suggests, we need to review our research agendas for interprofessional education, we surely need to review how we study interprofessional
communication. We can then choose Shannon and Weaver’s view of communication
as the transmission of symbols, or we can choose to view communication
through a more elaborate lens, one that considers how we live it every day. Lived
experience—an embodied approach—attests to the richness of what and how we
communicate. As Kogut and Zander [7] suggest, the word discourse is probably
more appropriate than information in this context. It draws attention to the critical
role played by language, symbol, and interpretation in the operations that bind
group members. There is probably much to gain by using an experiential approach
to research in interprofessional communication, one that recognizes that meaning
is based on the understanding of experience [8-10]. Knowledge thus acquired cannot
be dissociated from the experience of communication, rather than being framed
by an abstract theory (mathematical or otherwise). Models of experiential learning
and experiential research that combine experience with reflection, discussion, and
evaluation of that experience are a case in point [11,12]. The experiential here
includes all the basic sensory-motor, emotional, and social experiences available to
all human beings, and a balance is nurtured between head and heart, technical skills
and insightful compassion, and system design and the ethical dimensions of interprofessional practice [4,13].

The research agenda in interprofessional communication would then expand in
subject matter and methodologies (the plural is strongly intended). The subject is
indeed complex. Amid the variations in interpersonal styles of communication and
ways of transmitting what we know to others, there are also differences in perceptions
and how they can affect the participants in a discussion [14,15]. This complexity
is compounded by the speed of change in technology and how we adapt it to our
needs [16], whether in the real world or in a simulated one [17]. Added to this mix
is what the concept of a hidden curriculum implies: informal learning in interprofessional education cannot be denied [18], and in the same way that we know more than we can tell [19], we often express more than we can say.

To sum up, healthcare has one specific person-centered goal: solving patients’
problems. Communication is central to healthcare. It is more than information
transfer. It is also about reach, and reach can be costly. Interprofessional groups
have the potential to lessen the cost and create and communicate knowledge with
speed and efficiency. They are more likely to do so when they include an awareness
of human experience and use an experiential approach to understanding meaning
and communication. Otherwise, they are more likely to amplify the consequences
of the ongoing specialization and fragmentation of knowledge.

* Previously published as an editorial in JRIPE: http://jripe.org/index.php/journal/article/view/267

References
1. ginpole. (2010). Cool Hand Luke. YouTube. (Originally released in 1967) 1. URL: https://www.youtube.com/watch?v=yBBWUZfgRiw .
2. Dictionary of the English Language (5th ed). (2011). Reach. Boston, 2. MA: Houghton Mifflin Harcourt.
3. Shannon, C.E., & Weaver, W. (1949). The mathematical theory of communication. Chicago, IL: University of Illinois Press.
4. Soubhi, H., Colet, N.R., Gilbert, J.H.V., Lebel, P., Thivierge, R.L., Hudon, C., & Fortin, M. (2009). Interprofessional learning in the trenches: Fostering collective capability. Journal of Interprofessional Care, 23(1), 52–57.
5.Wenger, E., McDermott, R., & Snyder, W.M. (2002). Cultivating communities of practice : A guide to managing knowledge. Boston, Mass.: Harvard Business School Press.
6. Lawn, S. (2016). Moving the Interprofessional education research agenda beyond the limits of evaluating student satisfaction. Journal of Research in Interprofessional Practice and Education, 6(2), 1–11.
7. Kogut, B., & Zander, U. (1996). What firms do? Coordination,identity, and learning. Organization Science, 7(5), 502–518.
8. Dobie, S. (2007). Reflections on a well traveled path: Self-awareness, mindful practice, and relationship- centered care as foundations for medical education. Academic Medicine, 82(4), 422–427.
9. Ünal, S. (2012). Evaluating the effect of self-awareness and communication techniques on nurses’ assertiveness and self-esteem. Contemporary Nurse, 43(1), 90–98.
10. Beebe, S.A., Beebe, S.J., Redmond, M.V., & Geerinck, T.M. (2004). Interpersonal communication: Relating to others. Toronto, ON: Pearson Education Canada.
11. Henry, J. (1989). Meaning and practice in experiential learning. In S.W.I. McGill (Ed.), Making sense of experiential learning (pp. 29–33). Milton Keynes, UK: Open University Press.
12.Moustakas, C. (1990). Heuristic research: Design, methodology, and applications. London: Sage.
13. Lakoff, G. (1987). Women, fire, and dangerous things: What categories reveal about the mind. Chicago, IL: University of Chicago Press.
14. Buhler, A.V., Coplen, A.E., Davis, S., & Nijjar, B. (2016). Comparison of Communications Styles Among Students in Allied Health Professions Programs: How Do Our Students Communicate with Other Healthcare Providers? Journal of Research in Interprofessional Practice and Education, 6(2), 1–14.
15.McMillan, C., & Madill, J. (2016). A cross comparative study to examine beliefs and attitudes regarding food and eating between food and nutrition and social work students. Journal of Research in Interprofessional Practice and Education, 6(2), 1–17.
16. Graves, M. & Doucet, S. (2016). Factors Affecting Interprofessional Collaboration when
Communicating through the use of Information and Communication Technologies: A Literature Review. Journal of Research in Interprofessional Practice and Education, 6(2), 1–33.
17. Davis, D.L., Hercelinskyj, G., & Jackson, L.M. (2016). Promoting Interprofessional Collaboration: A Pilot Project Using Simulation in the Virtual World of Second Life. Journal of Research in Interprofessional Practice and Education, 6(2), 1–15.
18. Reade, M., Maar, M., Cardinal, N., Boesch, L., Lacarte, S., Rollins, T., & Jeeves, N. (2016). The impact of hidden curriculum in wilderness-based educational events on interprofessional competencies: A mixed-method study. Journal of Research in Interprofessional Practice and Education, 6(2), 1–16.
19. Polanyi, M. (205). Personal Knowledge. Chicago, IL: The University of Chicago Press.
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Can There be Harmony in Health Care Teams?

Here is a picture that I believe conveys charm, grace, harmony, happiness, a joy of being alive. This is the Guarneri Quartet in Munich, in 1969.

Guarneri munich_1969

Photo Credit: Irving Fisher

Can you conceive of a similar picture for a group of four health care professionals? Say, a neurosurgeon, a family physician, a nurse, and a physiotherapist? I cannot. Unless I imagine that they are very good friends coming out of a conference presentation, exhilarated by the applause they received, and now on their way to celebrate somewhere nice downtown.

Yet looking at the picture with the four musicians, my mind goes quickly: ‘’of course they’re happy! They’re musicians!’’

Why is it that I have to push my imagination a bit harder for a group of health professionals than for a group of musicians? My own feeble imagination is a possible answer. But that aside, I believe that there are significantly more pictures of groups of joyful musicians than of health care professionals. I think this is a testable hypothesis. I have not done the work. But I am willing to bet on it. I am also willing to bet that we will find more harmonious, seamless, and effective teamwork performance among musicians than among health care professionals.

This is of course my intuition, my first sense impression talking. But my cautious and critical brain would stop me right here: ‘’The hypothesis is sensible, but what do you mean by teamwork performance in the case of a music ensemble? How does that compare with health care performance; aren’t you comparing apples to oranges?’’

My own self-criticism would then go full speed when I realize that the Guarneri Quartet is particular in many ways: a very successful quartet, a group with an exceptional longevity, good-natured in their mutual relationships, and with a deep and abiding respect for each other. How frequent is that among musicians?

This is I think precisely the logic behind the empirical research conducted by Whitehead et al., published in the current issue of JRIPE, Vol 4, No 1 (see http://www.jripe.org/index.php/journal) on what health care professionals can and cannot learn from musicians. The authors recommend that we go beyond the charm of the idea that highly effective health care teams can evoke the performance of a music orchestra. Instead, they advise “we must understand the work that musicians put in and the difficulties that they face. Just as any other team, a chamber ensemble struggles to develop effective collaboration“. The comparison between music and health care must take into account the differences in the structures and the language of the two systems. Constructs that apply to one may not be relevant to the other.

The authors’ main finding is three-fold: musical groups have highly individualized identity; they have a deep understanding of the importance of non-melodic parts in music; and they interact differently in rehearsals and in a live performance. What follows is that a focus on generic interprofessional education skills may be insufficient, perhaps even misleading; the possibility of nuanced leadership models; and the need to take into account the variety of forms of group interactions in everyday health care practice.

As we look forward to a deeper understanding of the differences between the two, I like the charm of the idea of comparing the two. Take for example the lovely sound of a Schubert Concerto for violin and orchestra in D major: https://www.youtube.com/watch?v=zlNI1DVjjtE; or for a smaller group, take the Rondo for violin & string: https://www.youtube.com/watch?v=fqGj4stf6bE.

Watching these performances, I cannot help but wish we could have something similar among health care teams; something that conveys high levels of charm, grace, harmony, happiness, and the joy of being alive—all human aspirations that make life worth living.

Inching Away From the Barbarians*

Sociologist Talcott Parsons used the phrase “barbarian invasion” when he spoke of the birth of new generations of children [1]. I find a grain of truth in the phrase when I think of socializing new generations of healthcare students into their chosen professions. Acquiring the knowledge, attitudes, and values that would enable them to become functional members of their specific professional orders is a long, arduous, but necessary process—all the harder and all the more necessary when we try to socialize them into working with other professionals from different orders.

And doing so is unquestionable. For between the patient and the effective act of caring there has always been, and there will always be, a socialized group of assorted professionals—accepted and accepting members of society who fulfill the needed functions and roles of the group in solving the problems and riddles of illness.

I can see in the articles of this new issue of JRIPE (www.jripe.org) a complex view of such a group and the process of enculturation that is required to develop it. Time is not the only requirement. Layered upon time are other ingredients like favourable attitudes toward interprofessional education [2], interprofessional support for patient safety [3], accepting others on one’s own turf [4], understanding shared decision-making [5], enhancing students’ formulation of multidisciplinary roles [6], involving patients in health professional education [7], improving buy-in and sustainability of integrated models of care [8], and developing strategies for assessing collaborative competencies [9].

None of these ingredients are context-independent—to say nothing of their being assembled here for the purpose of this editorial. Another set of accepted articles might have garnered a different set of ingredients. So no one-size-fits-all solution will ever be in view. Complex problems require multiple platforms from which to handle them. Enculturation of successive generations of students and professionals into interprofessional working will have to continue, inching forward, with a rigorous scientific enterprise to light the way. That is the price to pay for a situated, contextualized, and responsible participation in healthcare. And we would be all the wiser to expect more new questions than answers from any research worth its salt.

* Published as an editorial in http://jripe.org/index.php/journal/issue/view/9         

References (available at http://jripe.org/index.php/journal/issue/view/9)

1. Parsons, Talcott. (1951). The social system. Glencoe, IL: Free Press.

2. Medves, J., Paterson, M., Broers, T., & Hopman, W. (2013). The QUIPPED project: Students’ attitudes toward integrating interprofessional education into the curriculum. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 3–21.

3. Patterson, M., Medves, J., Dalgarno, N., O’Riordan, A., & Grigg, R. (2013). The timely open communication for patient safety project. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 22–42.

4. Kornelsen, J., Iglesias, S., Humber, N., Caron, N., & Grzybowski, S. The experience of GP surgeons in western Canada: The influence of interprofessional relationships in training and practice. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 43–61.  

5. Dunn, S., Cragg, B., Graham, I.D., Medves, J., & Gaboury, I. (2013). Interprofessional shared decision making in the NICU: A survey of an interprofessional healthcare team. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 62–77.

6. Dalrymple, L., Hollins Martin, C., & Smith, W. (2013). Improving understanding of teaching strategies perceived by interprofessional learning (IPL) lecturers to enhance students’ formulation of multidisciplinary roles: An exploratory qualitative study. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 78–91.

7. Doucet, S., Lauckner, H., & Wells, S. (2013). Patients’ messages as educators in an interprofessional health education program. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 92–102.

8. Moore, A.E., Nair, K., Patterson, C., White, J., House, S., Kadhim-Saleh, A., & Riva, J. Physician and nurse perspectives of an interprofessional and integrated primary care-based program for seniors. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 103–121.

9. Murray-Davis, B., Solomon, P., Marshall, D., Malott, A., Mueller, A., Shaw, E., & Dore, K. (2013). A team observed structured clinical encounter (TOSCE) for pre-licensure learners in maternity care: A short report on the development of an assessment tool for collaboration. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 122–128.

Updating belief in Inter-Professional Education

How strong is your belief in the efficacy of IPE interventions? You may respond by saying “pretty much” if you believe it works, or “nil” if you don’t. You may also say “I don’t know, I’m not convinced; maybe it works, maybe it doesn’t” or “it depends”. Behind all these answers is a probabilistic statement, an assessment of how likely you believe IPE works.

Portrait used of Bayes in the 1936 book Histor...

You can actually quantify your belief. Reverend Thomas Bayes (learn more about Bayes and Bayes’ theorem at: http://en.wikipedia.org/wiki/Thomas_Bayes#Bayes.27_theorem) called this the prior: the amount of belief you start with when confronting an event or a situation. Expressed as a ratio between 0 (zero certainty) and 1 (complete certainty) or a percentage, this can be your subjective assessment of how likely something is to happen or be, e.g. how effective IPE is.

Once the event or situation happens, you can say “see I told you” if what happens agrees with what you thought would happen. If it doesn’t, you may say “well, I’m not an oracle; obviously, I can’t predict the future!”.

Sometimes, what happens is only partly what you thought would happen and this gives you some confidence in your predictive abilities; you might then say “Hum! I was partly right” and the next time you are asked about your belief in what would happen, you would feel more confident in your assessment of what would happen.

If you do that, it means that you have changed your prior belief in the event or situation you are considering. You would have updated your belief based on the new information provided by what happened.

Can we update our belief in IPE interventions? Do we have some new information that can change our prior belief (probabilistic assessment) in IPE? We do.

In the new issue of JRIPE (www.jripe.org), Packard et al. [1] published a study that tested a specific hypothesis: Students’ performance working up a case and perceptions of interprofessional skills would improve if they are given modeled examples of interprofessional communication and a team reasoning framework.

Eighteen students from dentistry, medicine, nursing, occupational therapy, pharmacy, and physical therapy were randomized to teams of six and were videotaped while completing a patient’s case. Team 1 (control) received only the case; team 2 received the case plus framework; and team 3 received the case, framework, and was shown videotaped examples of interprofessional interactions.

The authors hypothesized that the use of the framework would be associated with better student perceptions about working as part of a team and would also correlate to better student performance in working up the patient case.

Comparing the three groups, Packard et al. found that students’ perceptions of team skills were significantly improved in team 2 and team 3 but not team 1. Students’ performance of their case as assessed by blinded faculty was significantly better in team 3 compared with teams 1 and 2.

What does this means? To answer this question, let’s just review what the authors did and what we can infer from it.

First, there was a random allocation of students to three different groups. That any of the students ended up in team 1 or 2 or 3, did not depend on any characteristic of the student or the choice of the researchers.

Second, the researchers assessed the students’ perception of team skills before and after the study completion. They also compared the three groups of students for their performance of the case.

Third, and this is a slightly different way of seeing the second point, the students went through a process of change; they went from point A to point B, where A is some specific way of seeing team skills and B another way; they also arrived at a specific level of performance of their case that they would not have arrived at had they not been through the experiment. Those who changed the most were those who received all the components of the intervention (the case, the framework, and videotaped examples of interprofessional interactions).

The central question is whether these changes and the differences between the three groups could have happened by chance. Since the analysis showed that the differences were statistically significant, they could not have been due to chance; there is one most likely explanation for these changes. What is it?

The most likely explanation is the compound effect of the intervention. The three groups were comparable in all other factors, the only thing that differentiated them was the fact that one group received all the components of the intervention while the other two groups received only some of the components of the intervention or nothing. In other words, the three groups are comparable for all other factors that may explain the differences in the changes after the study. And they are also different in terms of the dosage of the intervention; there is a kind of gradient dose (of the intervention)/response: going from nothing, to using the framework, to using the framework and videotaped examples of interprofessional interactions.

So the take-home message, is that the most likely explanation for the differences between the three groups is the compound effect of case + framework + videotaped examples of interprofessional interactions.

What alternative explanations can we have? here are a few:

The students in the third group were actually good to begin with;

The change in perception of team skills was just a chance event;

Those who evaluated the students’ performance were biased; they misjudged what they were looking at.

The randomized, blinded nature of the study allows us to say that these explanations of the differences between the groups are the least likely.

So by now, you can update your belief in similar IPE interventions. You can update your probabilistic assessment of the efficacy of IPE interventions (similar to the one the authors used) based on the new information that this study provides.

What did the authors leave us with? They left us with three things:

1. A working hypothesis that can be tested in future research. The authors propose “that because the framework is comprehensive and represents issues of context in case management, it provides enough distributed intelligence to support interprofessional teamwork.”

Experiments could be carried out and the results analysed to confirm, refute or refine the hypothesis. Future studies would define what is meant by distributed intelligence, how it can be measured and how it would be linked to using the framework.

2. They thought others might want to use the framework and thought of a way to optimize its use in teaching an interprofessional course. They created a website with sample cases and tools to teach the framework:

http://oisse.creighton.edu/Interprofessional%20Case%20Studies%20Resources.aspx

3. Finally, they plan for the near future to determine the efficacy of the framework in another context: that of interprofessional Team Observed Structured Clinical Encounters (TOSCEs).

So kudos to the authors. I, for now, have updated my beliefs that IPE can work. My earlier update was in 2010 when another randomized study, also published in JRIPE, showed how IPE can work [2].

Have you updated your beliefs in IPE?

English: Icon representing Bayesian statistics

English: Icon representing Bayesian statistics (Photo credit: Wikipedia)

References (pdf available at http://www.jripe.org):

1. Packard, K., Chehal, H., Maio, A., Doll, J., Furze, J. Huggett, K, Jensen, G., Jorgensen, D., Wilken, M., & Qi, Y. (2012). Interprofessional Team Reasoning Framework as a Tool for Case Study Analysis with Health Professions Students: A Randomized Study. Journal of Research in Interprofessional Practice and Education 2(3), 250-263.

2. Just, J.M., Schnell, M.W., Bongartz, M., & Schulz, C. (2010). Exploring effects of interprofessional education on undergraduate students’ behaviour: A randomized controlled trial. Journal of Research in Interprofessional Practice and Education, 1(3), 182-199.

Complex Care and the Need for Collaborative Brains*

With the rising complexity of patient care comes a rising need for collaborative work. The articles in JRIPE’s sixth issue (www.jripe.org) explore two important questions in this regard: How should we organize collaborative work? And how should we prepare future generations for it?

Packard et al. [1] test whether students’ performance working up a case and perceptions of interprofessional skills would improve if they are given modeled examples of interprofessional communication and a team reasoning framework.

Holmqvist et al. [2] highlight the need for co-ordinated research efforts to determine the usefulness of student-run clinics as ideal sites to advance learning in teamwork and social accountability.

Newhouse et al. [3] add to our understanding of how to design effective heart failure management programs. Using a Delphi process, they report data from a series of consultations among health professionals, patients, and family caregivers.

Hutchison et al. [4] test the hypothesis that clinical pharmacists, physicians, and other healthcare professionals providing medication therapy management can improve outcomes and reduce costs among patients at high risk of adverse reactions from medication.

Arar et al. [5] provide insights into the cycles of growth through which multidisciplinary research teams operate. And finally, Butson et al. [6] examine the problems that can affect the creation of interprofessional virtual communities of practice.

All of these studies reflect variations on the theme of care complexity and the need for multidimensional platforms to address that complexity. These studies also highlight the kinds of skills we need to hone—dialogue, compassion, attention to the other, extending loyalties, and social interdependencies.

Indeed, when care is complex, when interactions among health professionals and patient become intricate, with the need to process higher amounts of information, it pays to hone our collaborative brains to broaden our perspective, widen our insights, and extend our predictive abilities. Such collaborative brains would work their way, through successive approximations, toward a better understanding of interprofessional practice. Armed with ideas, tools, and vocabulary, they would elevate their approaches to problems—each new understanding building on another, each new insight the source of a productive vitality that can carry the group for a while, until the next problem, the next challenge to its imagination, the next insight.

* Published as editorial for JRIPE, Vol 2 (3), 2012.  http://www.jripe.org/index.php/journal/issue/current

References (available as pdf at http://www.jripe.org/index.php/journal/issue/current)

1. Packard, K., Chehal, H., Maio, A., Doll, J., Furze, J. Huggett, K, Jensen, G., Jorgensen, D., Wilken, M., & Qi, Y. (2012). Interprofessional Team Reasoning Framework as a Tool for Case Study Analysis with Health Professions Students: A Randomized Study. Journal of Research in Interprofessional Practice and Education 2(3), 250-263.

2. Holmqvist, J., Courtney, C., Meili, R., & Dick, A. (2012). Student-Run Clinics: Opportunities for Interprofessional Education and Increasing Social Accountability. Journal of Research in Interprofessional Practice and Education 2(3), 264-277.

3. Newhouse, I., Heckman, G., Harrison, D., D’Elia, T., Kaasalainen, S., Strachan, P.H., & Demers, C. (2012). Barriers to the Management of Heart Failure in Ontario Long-Term Care Homes: An Interprofessional Care Perspective. Journal of Research in Interprofessional Practice and Education 2(3), 278-295.

4. Hutchison Jr., R.W., Hash, R.B., & Nault, E.C. (2012). Multidisciplinary Team of a Physician and Clinical Pharmacists Managing Hypertension. Journal of Research in Interprofessional Practice and Education 2(3), 296-302.

5. Arar, N.H., & Nandamudi, D. (2012). Advancing Translational Research by Enabling Collaborative Teamwork: The TRACT Approach. Journal of Research in Interprofessional Practice and Education 2(3), 303-319.

6. Butson, R., Hendrick, P., Kidd, M., Brannstrom, M., & Medberg, M. (2012). Developing a Virtual Interdisciplinary Research Community in Clinical Education: Enticing People to the “Tea-Room.” Journal of Research in Interprofessional Practice and Education 2(3), 320-338.

Published Research, Data, and the Promise of Understanding*

There is something comforting about categorizing objects and events in the world. Categories provide structure to what we see and what we talk about. They are often useful real-world distinctions that extend our capacity to understand and intervene in the world. Scientific instrumentation extends that capacity further, and I believe that scientific publications can do the same. Scientific articles can serve as springboards for reflection, conception, and intervention in the same way that a telescope can open the skies to our eyes and expand our knowledge of the cosmos; hence my commitment to JRIPE as an open access journal for the dissemination of peer-reviewed research.

In this issue (available in PDF at http://www.jripe.org/index.php/journal/issue/view/7), we publish seven new research articles for which I offer the following categorization. The first three articles can be grouped on the basis of their research method. Using a Participatory Action Approach, Huijbregts et al. [1] describe a pilot study of the implementation of a Canadian mental health guideline in a long-term care residence; Baker et al. [2] use Action Research to develop an educational module on Adult Suctioning for multi-professional groups of students; and Brynes et al. [3] report on the development and evaluation of collaboration in three clinical settings in Southeastern Ontario, Canada, using a quasi-experimental research design.

The next two articles have their unit of analysis as their most salient aspect. Not that these studies were without method; they used specific research designs to collect data, but their particular distinction was in the target of their analyses; namely, students and their interprofessional learning needs. Baerg et al. [4] explore collaboration learning needs among health professionals, teachers, and students, while Flynn et al. [5] reports on differences between Family Medicine Residents and other healthcare learners.

The last two studies have common ground in their research settings: rural communities in Australia. Jacob et al. [6] investigate the perceptions of and opportunities for interprofessional education from the perspectives of staff from three rural health services, and Woodrofe et al.[7] report on three years of results from a mixed methods evaluation of the Australian Interprofessional Rural Health Education Pilot. As both studies seem to suggest, the rural context may be an ideal place to showcase effective interprofessional practice.

We will never have an omniscient view of the nature of interprofessional learning and practice. We can only have categories and forms of reasoning about it. You will find plenty of both in the articles in this issue. How accurate those forms are is an empirical question which only sustained data collection can answer—more or less completely, and more or less precisely, depending on research design and the string of limitations that all scientists worth their salt acknowledge unabashedly. May the data keep coming and may our understanding of interprofessional education keep improving.

*Published as an editorial in Vol 2, Issue 2 of JRIPE at www.jripe.org

References (available at: http://www.jripe.org/index.php/journal/issue/view/7)

  1. Huijbregts, M., Guttman, Lisa, Sokoloff, X., Feldman, S., Conn, D.K., Simons, K., Walsh, L., Dunal, L., Goodman, R., Khatri, N. (2012). Journal of Research in Interprofessional Practice and Education, 2(2), 134-151.
  2. Baker, C., Medves, J., Luctkar-Fluke, M., Hopkins-Rosseel, D., Pulling, C., & Kelly-Turner, C. (2012). Evaluation of a simulation-based interprofessional educational module on adult suctioning using action research. Journal of Research in Interprofessional Practice and Education, 2(2), 152-167.
  3. Byrnes, V., O’Riordan, A., Schroder, C., Chapman, C., Medves, J., Paterson, M., & Grigg, R. (2012). Southeastern interprofessional collaborative learning environment (SEIPCLE): Nurturing Collaborative Practice. Journal of Research in Interprofessional Practice and Education, 2(2), 168-186.
  4. Baerg, K., Lake, D., & Paslawski, T. (2012). Survey of interprofessional collaboration learning needs and training interest in health professionals, teachers, and students: An exploratory study. Journal of Research in Interprofessional Practice and Education, 2(2), 187-204.
  5. Flynn, L., Michalska, B., Han, H., & Gupta, S. (2012). Teaching and learning interprofessionally: Family medicine residents differ from other healthcare learners. Journal of Research in Interprofessional Practice and Education, 2(2), 205-218.
  6. Jacob, E.R., Barnett, T., Walker, L., Cross, M., Missen, K. (2012). Australian clinicians’ views on interprofessional education for students in the rural clinical setting. Journal of Research in Interprofessional Practice and Education, 2(2), 219-229.
  7. Woodroofe, J., Spencer, J., Rooney, K., Le, Q., & Allen, P. (2012). The RIPPER experience: A three-year evaluation of an Australian interprofessional rural health education pilot. Journal of Research in Interprofessional Practice and Education, 2(2), 230-247.

Emoticons and Interprofessional Education: A Topic for Research?

By Lindsey Wright* & Hassan Soubhi

Interprofessional Practice and Education (IPE) helps understand how groups of professionals from different fields learn and work together. A key factor in achieving IPE is making certain that the different members of the group form a cohesive working relationship using as many tools as possible. In today’s technological society, diverse people need to find ways to communicate effectively. This can be from many technological platforms such as collaborating information through online classes and message boards, social networking, and more.

One way to optimize communications may be with emoticons. Attitude towards emoticons is as variable as the people who use them. For example, a manager might send a quick email or text to an employee that lets the person know they are doing a good job and add a smiley face at the end for added effect. Similarly, a team leader might have to let his or her team know they will be working late and add a frowny face to let everyone know it’s an unpleasant job, but it needs to be done. Using emoticons in this way may help to foster a positive work environment and allow all the different members of a team to feel connected.

In particular, younger members of a group are more likely to use emoticons more often than older team members. Having grown up in an environment in which texting and symbols often replace real speech, younger members use emoticon to add a tone to a sentence that might otherwise be misinterpreted. For example, when sending an email message about an error, they may include  an emoticon at the end of the message to indicate the benign nature of the error.

Several lines of research evidence from neuroscience suggest potential explanations for how emoticons might have these effects. Research indicates that our brains are able to mirror not only other people’s emotions (what they feel), but also their understanding of things (how they see things cognitively). Research also suggests that people make personality inferences from facial appearance despite little evidence for their accuracy, and an important part of the mirror neuron system seems even implicated in persuasion.

However, experts remain divided about whether emoticons might be used both within a familiar setting and in professional correspondence. In the blog “The Work Buzz,” author Kaitlin Madden addresses the importance of being professional in correspondence, specifically stating that emoticons are strictly forbidden, as well as “text abbreviations,” such as LOL (laughing out loud) or using “B” instead of the word “be.”

In the end, using emoticons seems to be based upon the sort of correspondence being sent, as well as the relationships between sender and receiver. Someone wanting to send an informal email to a colleague might be perfectly at ease with adding an occasional emoticon to the message. On the other hand, someone sending a letter to a potential client or to someone involved in a professional capacity will want to stay away from using emoticons or anything that might detract from the message itself.

As for IPE, if IPE is about learning with, about, and from each other, then emoticons might have a role to play in optimizing that learning. Considering how many times we use e-mails in our daily communications and the great strides that neuroscience is making in understanding how the brain affect our communications, there seems to be a limitless supply of research questions to answer. How effective emoticons are in promoting a positive work environment for IPE is one of them.

*Lindsey Wright is fascinated with the potential of emerging educational technologies, particularly the online school, to transform the landscape of learning. She writes about web-based learning, electronic and mobile learning, and the possible future of education (http://www.onlinecollegeclasses.com).

References

Pillay, Srinivasan S. (2010). Your Brain and Business: The Neuroscience of Great Leaders (Kindle Locations 1447-1448). Pearson Education (USA). Kindle Edition.

Said, C.P., S.G. Baron, and A. Todorov, “Nonlinear amygdala response to face trustworthiness: contributions of high and low spatial frequency information.” J Cogn Neurosci, 2009. 21(3): p. 519–28.

Gallese, V. and A. Goldman, “Mirror neurons and the simulation theory of mind-reading.” Trends Cogn Sci, 1998. 2(2): p. 493–501.

Kaplan, J.T. and M. Iacoboni, “Getting a grip on other minds: mirror neurons, intention understanding, and cognitive empathy.” Soc Neurosci, 2006. 1(3–4): p. 175–83.

Online College Classes and Academic Courses for Lifelong Learners. Web. <http://www.onlinecollegeclasses.com/&gt;.

Madden, Kaitlin. “7 Tips for Improving Email Etiquette.” The Work Buzz. CareerBuilder.com, 6 June 2011. Web. <http://www.theworkbuzz.com/on-the-job/work/office-etiquette/improve-email-etiquette/&gt;.